Patient Safety in Primary Care: Are General Practice Nurses the Answer to Improving Warfarin Safety? An Australian Perspective

Abstract

Primary health care plays a pivotal role in health systems. The ageing population and mounting prevalence of chronic disease will place increasing demands on primary care. Currently, 30% of general practice patients in Australia are aged 65 and over (Australian Institute of Health and Welfare 2009) and almost half of general practice consultations involve a chronic condition (Knox et al. 2008). Older patients with chronic conditions often have multiple co-morbidities and medications, requiring general practitioners (GPs) to coordinate and case manage their care. Managing such complex patients poses challenges for GPs who are often time poor (Jacobsen et al. 2003), which results in an increasing reliance on shared care and patient self-management. This potentially increases the risk of patient safety incidents such as medication-related adverse events. Patient safety, which refers to “the reduction of risk of unnecessary harm associated with health care to an acceptable minimum,” (Runciman et al, 2009, p. 19) is a fundamental principle of health care influenced by a number of interrelated factors, related to individual patients, health professionals, policies, guidelines, and regulatory procedures. In this paper, we present the example of warfarin management to illustrate safety and quality issues in the Australian primary care setting.